- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $812.83 / $812.83
| Facility | | $79.43 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,365.16 / $8,317.64
| Facility | | $1,479.11 | $4,365.16 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $3,019.95 / $7,244.36
| Facility | | $1,862.09 | $3,019.95 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $5,754.40
| Facility | | $2,344.23 | $2,884.03 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $269.15 / $2,238.72
| Facility | | $91.20 | $269.15 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $6,456.54
| Facility | | $1,000.00 | $2,691.53 | $6,456.54 |